Schizophrenia: Classification & Diagnosis

Specification: Classification of schizophrenia, Positive symptoms of schizophrenia, including hallucinations and delusions, Negative symptoms
of schizophrenia, including speech poverty and avolition, Reliability and validity in diagnosis and classification of schizophrenia including
reference to co-morbidity, culture and gender bias and symptom overlap

Links to issues and debates

 Ethics – e.g. issues of diagnosing mental disorders such as using labelling.
 Practical issues in the design and implementation of research – e.g. qualitative vs. quantitative data, balancing validity with reliability.
 Psychology as a science – e.g. in treatments such as drug therapies.
 An understanding of how psychological understanding has developed over time – e.g. DSM changes.

Schizophrenia is a very serious mental disorder. It is a type of psychosis and severe mental disorder where thoughts and emotions are so
impaired that contact is lost with external reality.
Around 1% of the world’s population suffer from schizophrenia.
Symptoms vary drastically between people and usually interfere with everyday tasks; to such an extent that hospitalisation may be needed. It is
found to be more common in men (than women), in cities (than countryside), working class (than middle class). It is most often diagnosed in 15-
35 year olds.

Classification of Schizophrenia
Schizophrenia doesn’t have one single defining characteristic. Rather individuals experience a cluster of symptoms that are not always related.
There are two major systems for diagnosis and they differ in their diagnosis of schizophrenia.

International classification of diseases (ICD-11) commonly used in Europe.

Diagnostic statistical manual (DSM -5) Most commonly used in USA.

Wider reading- Is there a stigma to mental illness?- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353607/pdf/MSM-10-70.pdf

Symptoms of Schizophrenia
The symptoms of schizophrenia are divided into POSITIVE AND NEGATIVE SYMPTOMS:

Positive symptoms are an EXCESS or Negative symptoms are a REDUCTION or

ADDITION of normal function LOSS of normal function

Delusions These can sometimes be paranoid. These are irrational beliefs that have no basis in reality and can take many forms.
They seem very real to the person, but are not real. For example believing that you are an important
historical/political/religious figure e.g. Jesus, The Queen. This is known as a delusion of grandeur. Another example
is believing your phone is tapped and people are listening in to your conversations or there are hidden cameras in
your home. It commonly involves the belief of being persecuted by people who have power. E.g. the government.
Another type is where they believe that their body is being controlled by some external factor e.g. receiving messages
from the TV or radio. These are known as delusions of reference. Some delusions can lead to aggression but not
always.

Hallucinations Bizarre, unreal perceptions of the environment. They are usually sensory (sight, sound, taste, touch, smell). They
sometimes bear no relation to what the senses are picking up in the environment, meaning they have no basis in
reality. E.g. hearing voices that aren’t there, that may be talking to them, criticising them etc., seeing an animal that
isn’t there. Sometimes, they do relate to something and might be a distortion of something that is there. e.g. seeing
distorted faces of people.
Negative symptoms Affective flattening refers to a reduction in the range and intensity of emotion; facial expression, voice tone and eye
contact.
(affective flattening,
alogia, avolition) Alogia refers to poverty of speech eg. Lessening of speech fluidity and productivity. This is thought to reflect
slowing or blocked thoughts. Can also include delayed responses during conversation. Speech may also be
disorganised – where it becomes incoherent and changes mid sentence. They may slip from one topic to the next
(derailment) mid sentence or it may be completely incoherent and sound like gibberish.
 Avolition is the reduction of or inability to initiate and persist in goal directed behaviour. Can often be mistaken for
disinterest. The individual cannot engage with any activities and lacks motivation. Signs of this include; poor hygiene
and grooming, losing interest in school/work, lack of energy. In some cases this can present as catatonic behaviour.

Diagnosis
Although there are clear differences between ICD-11 and DSM-5, generally speaking, the following need to be present in order for a diagnosis
of schizophrenia to be made;

A. The person must have at least one (ICD-11) or two (DSM-5) clear symptom(s) that is characteristic of schizophrenia such as delusions,
hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, negative symptoms - affective flattening, alogia or
avolition
B. The symptom must have been present for at least 1 month, and the disturbances to their life must have been present for at least 6 months.
C. The symptoms must be having a negative impact on the person’s social functioning or their occupation, such as work or studies.

Explain what is meant by the ‘positive symptoms of schizophrenia’ (4 marks)

Explain the term ‘avolition’ (2 marks)

Wider learning
https://www.youtube.com/watch?v=bWaFqw8XnpA- Note any of the symptoms / positive and negative for each of the 4 patients.

Claudia Hammond presents a father's story of his son's struggle with schizophrenia- http://www.bbc.co.uk/programmes/b006qxx9

Can we trust a diagnosis?

Rosenhan – being sane in insane places 1973- https://www.youtube.com/watch?v=D8OxdGV_7lo (7:40)

Aim To see if diagnosis of mental illness was accurate

Method 8 healthy adults (pseudo patients) presented themselves at different mental hospitals in the US.
All claimed to hear a voice saying ‘empty’ ‘hollow’ and ‘thud’. All the rest of the information given was accurate.
When admitted to the hospital, all behaved normally.

Results

Conclusion